Thursday, 8 October 2015

Thinking about getting a mammogram in the Dallas-Fort Worth area? You might check carefully because the cost can vary from $50 to as much as $1,045.

How about an initial routine gynecological exam? Around Phoenix, those prices can range from $72 to $388.

According to an analysis released Wednesday, it can pay for women to shop around for health care, with mammograms and other routine services often costing far more in one office than in another. Researchers at Castlight Health, a company that helps businesses analyze health care prices, looked at 179 metropolitan areas and found that mammogram prices varied four-fold or more in Atlanta, Houston, Los Angeles, Miami, Philadelphia and Seattle, among others.

“The variation was shocking,” said Jonathan Rende, chief of research and development for Castlight, which is based in San Francisco and collects billing records from employers that show the prices insurers and patients pay. “It speaks to how broken the health care system is.”

The Castlight study is one of the first to look at price variation in women’s health services, and it did not explain what may be causing the disparities or publish the names of providers. However, otherstudies have identified a host of influences. Private insurers sometimes strike markedly different deals with hospitals, labs and doctors in negotiations that are driven by market power as much as the actual cost of care.

It’s leaving health care consumers in the dark. They are in weak positions to shop around as most medical professionals and insurers do not publish actual prices or make it easy to get quotes. Patients frequently defer to their doctors’ recommendations for where to get a test, and those physicians rarely consider price.

Many insurers pick up the costs for preventive screenings, such as mammograms. But even then employees can end up paying in less obvious ways when a company’s health care costs rise, such as through higher premiums or forgone salary increases.

Rende said prices of women’s health services were particularly important: “We’ve seen over the years that women are bigger consumers of health care than men in general and we wanted to drill into some of the more common services and see how those varied.”

Not every type of procedure Castlight examined had gigantic variations. The widest price difference for a follow-up visit with an obstetrician and gynecologist was in Phoenix, where the cheapest visit cost $57 and the most expensive one cost $137.

But Castlight found price differences in tests for the human papillomavirus (HPV)—which is linked to the risk of cervical cancer–of 10 times or more in the majority of the major metropolitan regions it examined. An HPV test in the Philadelphia-Atlantic City area ranged from $32 to $626, a 19-fold variation.

Castlight also found prices varied significantly between some regions, beyond what could be attributed to cost of living differences. The average price for a mammogram ranged from $485 in Sacramento, Calif., to $159 in Cincinnati. The average HPV test in Indianapolis was $165, five times the $32 price in Charlotte, N.C.